It's a personal story, but let it also serve as a public health rebuttal to the proposed ban on male circumcision that will be on the San Francisco ballot this November.

San Francisco's ballot initiative would prohibit circumcision on all males under the age of 18. It would allow no religious exemptions, and it apparently gives no regard to the numerous studies demonstrating that male circumcision can substantially reduceby more than 50%the transmission of the HIV virus during sex.

"Communities, and especially women, may benefit much more from circumcision interventions than had previously been predicted, and these results provide an even greater imperative to increase scale-up of safe male circumcision services," concludes a study published this year in the peer-reviewed journal Sexually Transmitted Infections.

circumcision vastly diminishes the chance of infecting women with the human papillomavirus that causes cervical cancer, studies suggest that circumcision also helps guard against the transmission of the HIV virus. In both cases, cells on the inside of the male foreskin are implicated in spreading the virus. But if the foreskin is removed, a source of infection is also removed.

The commonly believed notion that circumcised men cannot develop penile cancer can result in delays in diagnosis. Recent medical literature has failed to confirm the protective effect of circumcision on penile neoplasms. Physicians need to be aware that men circumcised after 1 month of age may be at higher risk for penile cancer than those never circumcised.

DISCUSSION

Cancer of the penis is an extremely rare malignancy with a predicted lifetime risk of 1 in 1437 men in the United States5and 1 in 1694 in Denmark,6representing 0.09% of all cancers and 0.16% of cancers in the male adult.5The risk factors for penile cancer (Table) include genital warts,7,8smoking,8,9past sexually transmitted diseases,7,10a sexual relationship outside marriage,7multiple sexual partners,8poor genital hygiene,7,8,11,12phimosis,7-10,13previous genital conditions (including urinary tract infection, genital warts, yeast infections, chlamydia, genital crabs, gonorrhea, genital herpes, syphilis, genital ulcers or sores),7penile rash (which lasted longer than 1 month) or penile tear,8chewing tobacco or areca nut, using snuff,9and postnatal circumcision.7,8Of these risk factors, a history of genital warts appears to be the most significant, leading experts to identify human papillomavirus (HPV) as the most common causative factor in penile cancer.14

Interestingly, genital warts are now more common in circumcised men,15and HPV-associated lesions are equally prevalent in circumcised and intact men. Penile intraepithelial neoplasia, although found rarely, is slightly more common in men with foreskins.16In one study of 11 men with carcinoma in situ of the penis, 10 had been circumcised as infants.17

The role of circumcision in preventing penile cancer has recently been called into question.19In addition to several publications documenting cancer in circumcised men,19-26a recent case control study of 110 men with penile cancer from the Pacific Northwest revealed that 41 (37%) had been circumcised.8Relative to men circumcised at birth, the risk for penile cancer was 3.04 times as great among men who were never circumcised and 3.55 times as great among men who were circumcised after the neonatal period. The magnitude of risk for developing penile cancer was similar in smokers, but a history of multiple sex partners or genital warts were the strongest risk factors (Table). While neonatal circumcision may play a small role in preventing penile carcinoma, 20% of the patients in this study were circumcised at birth.8When the control group was properly adjusted for age, there was no difference between the case group and control group in circumcision status.

Circumcision performed after the newborn period may increase the likelihood of penile neoplasms. In a Danish study, men with localized squamous cell carcinoma of the penis were 7.81 times as likely to have been circumcised after the newborn period as the general population.8,27Maden et al8demonstrated that men circumcised after the newborn period had a slightly higher risk when compared with those circumcised at birth.8

In an epidemiologic study with both retrospective and prospective cases from China, 157 men with penile neoplasms were identified. Circumcised men were markedly more likely to develop penile cancer than controls.7The circumcision scar is often the focus of tumor formation.19In Africa an uncontrolled study found that all of the circumcised men who developed penile cancer were circumcised late in adolescence or adulthood.28Why the timing of circumcision is a significant factor is unclear.

For the circumcision status of the patient to be missing from the chart for the past 60 years is indefensible, but not uncommon. In a series of penile cancer patients from the Mayo Clinic, 15% did not have their circumcision status documented in the chart.14Because circumcision is so prevalent in the United States, a circumcised penis is often described as "normal" in medical records, thus providing no useful information.

In spite of the body of evidence to the contrary, several circumcision advocates still profess that penile cancer is "virtually eliminated" by neonatal circumcision.1,28-31Having been given access to respectable medical journals, their errant message has been adopted by many mainstream physicians.14The persistence and prevalence of his myth may be detrimental, as evidenced by the 3-year delay in this patient between the time the penile lesion was noted and a biopsy taken.

---

Officials of the American Cancer Society do not recommend circumcision as a cancer preventative measure. (personal correspondence,H. Shingleton and C. W. Heath, Jr, to Peter Rappo, MD, Feb 16, 1996). Recognizing that circumcised men can acquire penile cancer are are at equal or higher risk for HPV-associated lesions is the first step in preventing penile cancer. Screening for, recognizing, and treating these lesions as they develop on the penis as is currently performed on the uterine cervix may be the most responsible approach to controlling both cervical and penile cancer; however the utility of such screening needs to be explored.16,32Persistent penile rashs are a highly significant risk factor for penile cancer8and should not be ignored.

Because of the absence of a national tumor registry in the United States, most of the epidemiological studies have been performed outside the United States. When the incidence of penile cancers from different countries are compared, the biggest factor appears to be indoor plumbing.33The downward trend in the incidence of penile cancer over the past 47 years in Denmark, where 1.6% of men are circumcised, has been partly attributed to better penile hygiene.6

Ironically, Denmark, in spite of its low circumcision rate, currently has a lower incidence of penile cancer than the United States, where 60% to 80% of men are circumcised.

Genesis 17:10-14This is my covenant, which ye shall keep, between me and you and thy seed after thee; Every man child among you shall be circumcised.And ye shall circumcise the flesh of your foreskin; and it shall be a token of the covenant betwixt me and you. And he that is eight days old shall be circumcised among you, every man child in your generations, he that is born in the house, or bought with money of any stranger, which is not of thy seed. He that is born in thy house, and he that is bought with thy money, must needs be circumcised: and my covenant shall be in your flesh for an everlasting covenant. And the uncircumcised man child whose flesh of his foreskin is not circumcised, that soul shall be cut off from his people; he hath broken my covenant.

So, apparently, the circumcision should be done before 1 month of age for there to be a clear health benefit.

Of course, that is just one study; my experience with studies such as that is that the data may or may not say anything, and the interpretations often reflect the biases of the researchers; i.e., other conclusions could be made with the same data. And the study results absolutely must be corroborated with other studies, and meta-analyses need to be done, etc.

I did a search of Pubmed (keywords: circumcision, circumcision risks, circumcision risks benefits) and couldn’t find anything on dangers of circumcision. One thing I found out is that the practice of circumcision is being introduced into Africa to try to reduce the incidence of AIDS. In Africa, unlike in the US, heterosexual AIDS is a huge problem.

15
posted on 05/25/2011 5:12:13 AM PDT
by exDemMom
(Now that I've finally accepted that I'm living a bad hair life, I'm more at peace with the world.)

Muslims have circumcision of males performed as well. The big thing is that having a sex-change operation is far worse than a child getting circumcised, and readily condoned by society. The latter has been done for thousands of years with very little problem. I personally would oppose this bill solely for it making little to no sense whatsoever. If you condone a man getting his privates mutilated and rearranged to resemble a woman, why should you care about some male child getting circumcised? Absolutely not at all.

We are truly a country of stupid rules and control. Circumcision should be a parental option or a religious one period. On a side note, when Mom was a nurse, she remembered on young boy of 19 who had it done. From my understanding, he felt “different” being an athlete and looking “different”. As an adult, the procedure is painful. It is also far more complicated than what newborns go through.

100 infants die per year due to complications from circumcision. I was involved with a case in Dallas where an infant had his whole penis cut off and had to have a sex change operation. My friend’s son had to be hospitalized because of an infection due to an “aggressive” circumcision.

. . . but you couldn’t come up with a thing.

BTW, I’m opposed to the law. If parents want to pay extra to have their infants mutilated, it’s their business.

I have no idea why they did it. I don’t think any male got picked for the jury. I wouldn’t want to have been that kid or his parents for any amount of money and the guys and most of the women wanted this doctor hung by his penis until dead before hearing anything about the case.

No. The doctor used a laser and it couldn’t be reattached. The whole thing was removed with the laser. I don’t even know how the doctor managed to cut the whole thing off. My involvement was very brief (less than one day), but long enough to learn the background. I wasn’t selected for the jury.

Oh you were involved in the court case not the medical side. I understand. Thanks for clarification. It looks like they could still have done something cosmetic since cosmetically they can give a sex change operation to a female. Instead they decided to remove the rest of his male organs, create female organs and put the poor child on hormones? Not to mention going back to family and friends and saying oh yeah we really have a daughter instead of a son. That is strange indeed!

According to my dad who didn't have it done until a very real health risk at the age of 64, it's was pure hell healing afterwards and he would have preferred it at the tender young age of being a new born. So even if you don't have it done at a young age - you still might HAVE to have it done later in life - if you want to live.

Demand that men wash before and after engaging in sex. If women would refuse to permit anal/vaginal sex, most of these diseases would disappear on their own. Inserting fecal bacteria deep into your vagina is not be something I would consider to be healthy if I was a woman.

31
posted on 05/25/2011 8:52:59 AM PDT
by B4Ranch
(Allowing Islam into America is akin to injecting yourself with AIDS to prove how tolerant you are...)

I made it very clear that I looked in Pubmed, *the* medical research database in use today. Every scholarly article published within the realm of medical research is catalogued there. Plus, I specified the keywords I used to search. If you can provide specific keywords to use in Pubmed, which will return the kind of article that will support your claim, please do so.

I’m not sure exactly how to classify the website you linked—sociology, maybe—but it does *not* appear to be a medical research database.

34
posted on 05/25/2011 5:35:56 PM PDT
by exDemMom
(Now that I've finally accepted that I'm living a bad hair life, I'm more at peace with the world.)

Really? What kind of question is that? Whether you agree with the practice or not, male circumcision has health benefits and does not deprive men of the desire or enjoyment of sex. Female circumcision does not have health benefits and is done purely to keep girls chaste. It ruins any enjoyment they have for sex and is barbaric.

Disclaimer:
Opinions posted on Free Republic are those of the individual
posters and do not necessarily represent the opinion of Free Republic or its
management. All materials posted herein are protected by copyright law and the
exemption for fair use of copyrighted works.